Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CONSULTATIONS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 847 records · Page 47Linked to original sources
PubMed2002

[Quality criteria for psychosomatic consultation-liaison service].

Besides the integrated psychosomatic models in various medical specialities (e.g. Internal medicine, Obstetrics and Gynaecology or Paediatrics), specific models of cooperation in the form of consultation-liaison (C-L) service between specialised psychosomatic-psychotherapeutic departments and other medical departments play a crucial role in providing psychosomatic care to patients. The concept 'liaison' expresses a particularly close form of cooperative activity, going far beyond the classical model of consultation services. In this context, the psychosomatic consultant has not only a fixed organised presence in the provision of patient care, he/she also participates in case discussions, hospital rounds, ward discussions and continuing education programmes of the 'partner' department. Thus, the liaison service is not only patient-centred, but also team-centred. Such consultation-liaison services, in Austria, were first established at the University Hospitals. As a consequence of laws regulating psychotherapeutic care, according to which such care is to be offered in general hospitals, increasingly C-L services are becoming part of regular care provision in more and more hospitals. Consensus groups, international as well as in German-speaking countries, are currently working on establishing quality standards in the area of psychosomatic C-L services. A working group of the scientific medical representatives has recently published guidelines for the structure, process and results of quality control. A second group, of the European Association of Consultation Liaison Psychiatry and Psychosomatics, is currently working on guidelines for training consultation-liaison service providers. In the present article, an overview of these projects will be presented and the results discussed against the background of the specific health policy situation in Austria.

Austria↗
PubMed2003

A comparison of two models of gynecology service consultation to the emergency department in an academic medical center.

OBJECTIVE: This study was undertaken to determine differences in resource use and outcomes when emergency department (ED) physicians consult the gynecology service routinely versus selectively. STUDY DESIGN: In July 2000, an ED policy of "routine" gynecology consultation for pregnant women less than 20 weeks' gestation with pain and/or bleeding complaints changed to a policy of "selective" consultation. Resource use and outcomes were compared for 222 women who received care during the 9 months before the protocol change with 268 women who presented during the 9 months after the protocol change. RESULTS: With selective consultation, patients receiving gynecology evaluations decreased from 74% to 39%. Return visits to the ED increased from 9% to 21%. Ultrasound studies performed by ED physicians and radiologists increased, whereas studies by gynecologists decreased. Patients waited longer and received more unnecessary human chorionic gonadotropin studies. CONCLUSION: A policy of selective gynecology consultation, compared with routine gynecology consultation in the ED, increases diagnostic study resource use and patient length of stay.

Abdominal Pain↗
PubMed1994

Leadership of mental health consultation groups: a model for group therapists.

Group therapists often lead consultation groups. For effective leadership it is important to distinguish between consultation groups and psychotherapy groups. A consultation group is one in which a leader serves as consultant to the members. Group process variables of task, contract, role of the leader, and effect of the larger system should be understood by the consultant. The process of defining, testing, and maintaining these variables encourages exploration of resistance and parallel process, and is an important aspect of the ongoing learning. Consultation group leaders should understand the importance of serving as group leader but not group therapist.

Group Processes↗
PubMed2004

The relationship between measures of patient satisfaction and enablement and professional assessments of consultation competence.

The authors examined the extent of the relationship between a Consultation satisfaction questionnaire and Patient enablement instrument scores and professionally assessed consultation competence scores of senior medical students. Three analyses were performed: (i) linear regression with mean overall competence score as response variable; (ii) sensitivity and specificity calculations using patient scores to classify competence; (iii) a repeated measures model with consultation-specific competence score as response variable. One hundred and nineteen students and 388 patients took part. Consultation satisfaction and enablement scores were weakly correlated with overall and consultation specific competence scores (correlation coefficient 0.16 to 0.44). 'Satisfaction with professional care' had a sensitivity of 0.68, specificity of 0.72 and positive and negative predictive values of 0.32 and 0.92 respectively. It is concluded that patient and professional assessments may complement, but do not replace, each other. Levels of patient satisfaction should not be used as proxy measures of the quality of consultation competence.

Adolescent↗
PubMed2006

'Losing my touch': decline in self-reported confidence in performing practical procedures in consultant oncologists.

This study aimed to compare the confidence of oncology consultants and specialist registrars (SpRs) in the performance of practical procedures, to contrast this with confidence in other areas of practice and to determine at what grade they felt most confident. Questionnaires were sent to all 57 oncology consultants and SpRs in the South-West region. Respondents scored confidence on a five-point Likert scale. The response rate was 70%. SpRs were significantly more confident in cardiopulmonary resuscitation (p = 0.003) and central line insertion (p = 0.006). Consultants were significantly more confident in developing management plans (p = 0.001) and performing committee work (p = 0.002). Only 6% of consultants felt most confident performing practical procedures as a consultant, and were less confident about these than other tasks (p = 0.001). Some 86% of SpRs considered they were more confident performing practical procedures as senior house officers (SHOs). In conclusion, self-reported confidence in performing practical procedures declines during career progression in oncology. This raises questions about the teaching and supervision of these procedures. If there is a greater emphasis on a consultant-provided service, their educational needs will need to be recognized and retraining or outsourcing of these procedures to other specialties may be necessary.

Clinical Competence↗
PubMed1999

How well do patient and general practitioner agree about the content of consultations?

OBJECTIVE: To analyse agreement between patients' and general practitioners' perception of content of consultations. DESIGN: Cross-sectional study based on paired questionnaires answered by patients and general practitioners (GPs). SETTING: General practices in the County of Funen, Denmark. SUBJECTS: All 291 GPs in the County were invited to join the investigation, and 137 accepted. All patients who consulted the participating GPs in a 3 day period were included in the investigation. The GPs registered 6021 patients, of whom 3578 (59%) returned the completed questionnaire. MAIN OUTCOME MEASURES: GPs and patients were asked about the urgency of the consultation, number of problems presented, duration of consultation, and quality of communication. The GPs' and patients' answers were matched, and variables of agreement were made. Patients were furthermore asked about their satisfaction with the consultation. RESULTS AND CONCLUSION: Agreement for the four matched answers varied from 69% to 83%. Disagreement was observed more often in consultations where the patient's self-evaluated health was poor, the patient was female, had a chronic disease, expected a prescription or felt that the GP had little knowledge of his/her life circumstances. Agreement concerning urgency, number of problems and quality of communication was associated with a higher degree of patient satisfaction.

Adult↗
PubMed2005

Consultations for injuries by frequent attenders are found to be medically appropriate from general practitioners' perspective.

AIMS: A study was carried out to determine whether frequent attenders' (FAs') consultations for injuries are medically appropriate or not. METHODS: A retrospective review was undertaken of medical records in a primary healthcare centre. All injury consultations by frequent attenders and controls during a period of one year were evaluated by two general practitioners (GPs). Outcome variables were: number of injuries, chronic diseases, type of injuries, and their treatments. The GPs made a comprehensive picture of each case and evaluated whether it was medically appropriate to consult a doctor or not. RESULTS: Injuries were 7.2 times more common among frequent attenders compared with the controls. Frequent attenders had significantly more chronic diseases. Mean number of injury consultations was the same for frequent attenders with or without chronic disease. There was no difference concerning medically appropriate consultations between frequent attenders and controls. CONCLUSIONS: Consultations for injuries with frequent attenders were considered medically appropriate. Chronic diseases did not explain the higher injury incidence among frequent attenders. These findings are interesting and contradict the opinion that increased healthcare consumption by FAs is a waste of resources. Our findings may suggest that FAs are more vulnerable individuals.

Adolescent↗
PubMed2004

Role of infectious diseases consultants in management of antimicrobial use in hospitals.

The Infectious Diseases Society of America Emerging Infections Network (EIN) surveyed its members to characterize antimicrobial restriction policies in their hospitals and the involvement of infectious diseases consultants in this process. Of the 502 respondents (73%), 250 (50%) indicated that their hospital pharmacies would not dispense certain antimicrobials without approval of infectious diseases consultants. Moreover, 89% agreed that infectious diseases consultants need to be directly involved in the approval process. At hospitals with control policies, commonly restricted agents included lipid formulations of amphotericin B, carbapenems, fluoroquinolones, piperacillin-tazobactam, and vancomycin. Only 46 EIN members (18%) reported remuneration of infectious diseases consultants for participation in the approval process. Pediatric infectious diseases consultants were more likely to practice in hospitals with restriction policies than were adult infectious diseases consultants (64% vs. 45%; P<.001). Similarly, teaching hospitals were more likely to have antimicrobial-control policies than were nonteaching facilities (60% vs. 17%; P<.001).

Anti-Infective Agents↗
PubMed2004

Why don't they listen? Adherence to recommendations of infectious disease consultations.

The effectiveness of an infectious diseases (ID) consultation is dependent on adherence to the recommendations. To delineate the factors that affect adherence, we conducted a prospective cohort study of 465 consultations at 2 academic institutions in which we evaluated the consultation process, patient and consultant characteristics, types of recommendations, and compliance with recommendations. The overall compliance rate was 80%, with 85% adherence to crucial recommendations. Multivariate analysis revealed that adherence to ID recommendations was higher when the recommendations were therapeutic instead of diagnostic, when they related to a specific clinical question, when recommendations were deemed crucial by the ID service, if the primary service was medicine, and if the consultation note was legible and organized. Whether modification of consultant practice will lead to improved recommendation compliance and patient outcomes warrants further study.

Adolescent↗
PubMed1996

"Telepsychometry": a remote psychometry consultation in clinical gerontology: preliminary study.

OBJECTIVE: Evaluation of the clinical feasibility of remote psychometric consultation with elderly patients. METHODS: Remote consultation with six women and four men (average age 87) was compared with a standard consultation. An interview and two psychometric tests were used: the Mini-Mental Status Examination (MMSE) and the Clock Face Test (CFT), which were administered by a clinical psychologist and controlled by a psychologist observer who remained in the room with the patient. The experimental setting consisted of two rooms linked by a coaxial cable. Each room was equipped with a camera, television screen, and microphone. The clinician was able to operate the mobile camera in the patient's room by remote control. The clinician was assisted by a computer, which helped to focus on standardized points. A video camera recorded the consultation for documentation purposes. RESULTS: Decreased performance was observed in the remote versus the standard consultation for both tests (MMSE: p = 0.008; CFT: p = 0.006). Physiologic hearing loss may have been responsible for a fall in the patients' attention. CONCLUSION: Remote psychometric consultation can be applied successfully to the psychological examination of elderly patients provided that communication problems are solved.

Aged↗
PubMed1995

Hospital services for patients with acute stroke in the United Kingdom: the Stroke Association Survey of consultant opinion.

A national postal survey of all UK hospital consultant geriatricians, general physicians and neurologists was performed in 1992/3 in order to describe the provision of hospital stroke services in the United Kingdom and to assess whether the recommendations of the King's Fund consensus conference on stroke had been widely implemented. Of 3478 survey forms, 2923 (84%) were returned and, of these 1953 (67%) consultants indicated that they routinely cared for patients with acute stroke. On their stated estimates, the survey respondents had admitted approximately 107,000 patients with acute stroke in the previous year, 40% of whom were cared for by geriatricians. Sixty-three per cent (1239/1953) worked in District General Hospitals. Few (5%) had access to an acute stroke unit, and a majority (51%) of consultants were uncertain of the benefits of such units. Less than half (44%) had access to a specialized stroke rehabilitation unit, but a majority (68%) were certain of the benefits of stroke rehabilitation units. Although a majority of consultants had on-site CT scanning, about a third of all UK stroke patients were admitted to a hospital without on-site CT facilities. Most (90%) consultants would want a CT scan themselves if they had a stroke. Only about a third of consultants were aware of a recent audit of stroke care in their hospital, or had a hospital policy for the implementation of minimum standards of stroke care, and less than half routinely provided written information for patients or carers. This survey illustrated that five years after the publication of the King's Fund consensus statement on the treatment of patients with acute stroke UK hospital stroke services are still poorly organized. Access to CT scanning for stroke patients is improving, but is still insufficient.

Acute Disease↗
PubMed1998

The Kaiser Permanente/USC Patient Consultation Study: change in use and cost of health care services.

The impacts of three alternative models of pharmacist consultation on the use and cost of health care services were studied. Two studies were conducted concurrently in an HMO over two years. In one, 6000 patients were randomly assigned to one of three consultation models; in the other, the three models were implemented in six geographic regions of California (4600 patients). The models were (1) consultation about new or changed prescriptions as mandated by state law (state model), (2) consultation focused on selected high-risk ambulatory care patients (Kaiser Permanente [KP] model), and (3) a control model. The patients were surveyed three times about their health status and satisfaction, and computerized data on health care use and cost were collected. The effect of the consultation models on the use and cost of health care services was examined across five risk groups that were based on drug-use profiles. An additional 37,750 patients (10% of the patients residing in the areawide study sites) were included in a supplemental analysis of the use and cost of health care services. There was no indication in the random-assignment study that pharmacist consultations affected either drug costs or the cost of office visits. Similar results were found in the areawide study, with the exception that the KP model was associated with lower drug costs than the control model. In the 10% sample, the KP model appeared to be associated with lower office visit costs but higher drug costs. Both models were associated with a lower likelihood of a hospital admission and with lower total health care costs for some high-risk patients compared with the control model. Counseling patients about their medications may be unlikely to reduce medication costs or the cost of office visits but may reduce the likelihood of hospital admissions and the overall costs of health care services; a combination of counseling patients at high risk for drug-related problems and counseling all patients about any new or changed prescription should be considered.

Adult↗
PubMed1995

Consultation in university-based and community-based infectious disease practices: a prospective study.

Infectious disease physicians in university and community practices completed a standard data form following each of 1,366 inpatient consultations during a 7-month period. The rate of consultation was higher in the university practice than in the community practice (3.4 vs. 1.8 per 100 discharges, respectively). Known or suspected bacterial pathogens accounted for more than half of all consultations in both practice groups. The three organ systems most commonly affected by infection were pulmonary (20% in university practice vs. 19% in community practice), skin and soft tissue (13% in university practice vs. 20% in community practice), and musculoskeletal (12% in university practice vs. 16% in community practice). Bloodstream infection, pneumonia, unexplained fever, osteomyelitis, urinary tract infection, and cellulitis were the six most common disease processes that led to consultation in both practice groups. The percentage of patients with noninfectious diseases and the percentage for whom a change in antimicrobial therapy was advised was nearly identical in both practice settings. Physicians in private practice performed more consultations on weekends (20% vs. 11% in university practices, P < .001) and between 6:00 P.M. and 7:00 A.M. (15% vs. 6% in university practices, P < .001). The scope and diversity of the work of consultants in community practices are nearly identical to those of their colleagues in university-based practices.

Communicable Diseases↗
PubMed1993

Is there a relationship between a mother's mental state and consulting the doctor by the family? A study in a military general practice.

A total of 174 families of service personnel with children between 3 and 6 years of age were studied over a 6 month period. All contacts with the general practitioner, both in and out of hours together with the local casualty department were recorded. Mothers of the children were posted a specially designed questionnaire to measure how seriously they perceived various childhood symptoms to be and a copy of the general health questionnaire, 28 question version (GHQ 28). The perceived severity questionnaire had been piloted previously in a neighbouring practice. The overall response rate was 77%. Analyses of the data showed that the factors most significantly associated with a child's consultation frequency were the psychological state of the mother, the mother's own consultation frequency and the number of children in the family; the last being an inverse relationship. No evidence was found to suggest that the perception of the severity of illness varied with the psychological state of the mother. In addition, the childhood consultation rate was not influenced by the mother's perception of the severity of childhood illness as measured by the perceived severity questionnaire. Other factors such as the age of the mother or child, within the age range studied, were not found to be significantly related to the child's frequency of consulting. A mother's own consultation frequency was highly correlated with her GHQ 28 score, but more specifically with the subsections that scored for depression and somatic symptoms. From the study, doctors who see children should seriously consider the main reasons for a child's consultation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

The effect of patients' attendance rate on the consultation in a health centre in Saudi Arabia.

An observational study in which patients attending a health centre in Riyadh during a typical working week were invited to participate was undertaken, in order to study the variability of patients' attendance rates at a health centre and identify any association with the length and content of consultations. Four hundred and sixty females and 442 males representing 63% of patients seen during the study period agreed to participate. There was an uneven patient attendance rate during the working hours of the study week with 10.16 consultations per doctor per hour in the evening compared with 5.58 in the morning. By international standards the average consultation time was short (5.09 minutes). Contrary to what was expected, the proportion of patients who had long consultation times (> 10 minutes) or were offered health education did not increase during the light work periods. Long compared with short consultations were more likely to include health education issues but did not differ significantly in the rate of prescription, investigation or referral. Recommendations as a result of the study include (i) suggestions to spread the work evenly and (ii) performing assessment and audit studies with the purpose of encouraging longer consultations and including health education more frequently.

Adolescent↗
PubMed1996

Interruptions during general practice consultations--the patients' view.

BACKGROUND: Although most aspects of the consultation have been extensively reported there is very little information on the effects of interruptions on the consultation. OBJECTIVE: We wished to discover the patients' view of interruptions. METHODS: In this pilot study the sources and frequency of interruptions to the consultations of a single general practitioner were measured. The effects of interruptions on 102 patients whose consultations were interrupted were then ascertained using a simple questionnaire. RESULTS: The overall interruption rate was found to be 10.2%. The telephone was the commonest source of interruption, accounting for 50% of interruptions. Although most patients did not perceive the interruption as having an important effect on the consultation, 20% of patients did feel that the interruption had a bad effect on the consultation and 40% of patients felt it would have been better not to have been interrupted. A majority of patients (52%) did not feel that the reason for the interruption was important. Although most patients did not feel affected by the interruption, a significant minority (18%) of patients had a strongly negative emotional response to the interruption. CONCLUSIONS: In view of these findings the need for further work has been highlighted.

Adolescent↗
PubMed2000

'Strong medicine': an analysis of pharmacist consultations in primary care.

BACKGROUND: Patients often find it difficult to discuss their medications fully with their prescribing doctor. Little is known about what might be said about medications to another professional within the primary health care team (PHCT). Pharmacists are seeking to extend their role within primary care and are ideally placed to provide independent medication advice. OBJECTIVE: Our aim was to test the feasibility of using primary care pharmacists as medication counsellors, and to analyse the content of their consultations using qualitative methods. METHOD: Some patients were referred by their doctors, some self-referred and others were invited by the pharmacists for medication reviews. Pharmacist-patient consultations took place within GP surgeries and in patients' homes, and were audiotaped, transcribed and analysed qualitatively. The study sample consisted of 25 consultations with three primary care pharmacists conducted over a 3-month period. RESULTS: Referrals from the doctors were slow and there were no referrals from nurses. The pharmacists, who all had clinical backgrounds and were not dispensing pharmacists, experienced few problems with the consultations. Patients were willing to discuss their medications in detail with the pharmacists. A theme emerged regarding the perceived potency of medications, and this seemed to have an effect on the experience of side effects and the perceived efficacy of the medications. CONCLUSIONS: From this small study, it would seem that pharmacist consultations within primary care are a feasible extension of their current role as prescribing budget advisors. The richness of the consultations reflects the acceptability to patients. Feedback of information to other members of the PHCT, given patient consent, would be very useful for a better understanding of the patient's perspective, which in turn would facilitate concordance in the negotiation of the patient's management.

Feasibility Studies↗
PubMed1991

Connections between the quality of consultations and patient compliance in general practice.

The aim of the study was to generate and test a theory about connections between the quality of consultations and patient compliance in general practice. The theory was empirically based on patient interviews in order to understand the patient's perceptions and behaviour, and on development of a list for mapping of consultations, which in turn allowed coherent descriptions of consultations and compliance. The theory suggests and explains that compliance is connected with the fulfillment of six relatively simple criteria for the quality of consultations. The theory was tested by comparing predictions of compliance derived from analyses of 63 consultations with patient questionnaire based measurements of compliance. The difference between proportions of patients who were complaint after consultations fulfilling and not fulfilling respectively the criteria was 44%. The 95% confidence limits of this difference were 21% and 67%.

Family Practice↗